England plans to de-centralize control of health care system

In a surprise move, the new coalition government in the UK announced a plan to decentralize control of their massively inefficient and uncaring health care system. (story here from the NY Times) While the US careens toward government-controlled health care, the UK, whose system Donald Berwick professes to love, is moving away from government control.

Even as the new coalition government said it would make enormous cuts in the public sector, it initially promised to leave health care alone. But in one of its most surprising moves so far, it has done the opposite, proposing what would be the most radical reorganization of the National Health Service, as the system is called, since its inception in 1948.

Practical details of the plan are still sketchy. But its aim is clear: to shift control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level. Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use the money to buy services from hospitals and other health care providers.

The plan would also shrink the bureaucratic apparatus, in keeping with the government’s goal to effect $30 billion in “efficiency savings” in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.

The tales of woe coming from Britain’s broken health care system illustrate that the government has failed spectacularly in providing even basic health services to its citizens. A recent article (from the Daily Mail) details how hospital staff have to be reminded to feed patients – millions of patients suffer malnutrition during hospital stays. One would think that this would be part of health care 101 – feed the patients. Not so in the NHS, apparently.

For a system that has grown into a monstrous, Jabba the Hut, slug-like bureaucratic morass, this is a significant development. Even though it is not privatization (doctors are still government employees), it opens the door for private entities to enter the system down the road.

Dr. Richard Vautrey, deputy chairman of the general practitioner committee at the British Medical Association, said general practitioners had long felt there were “far too many bureaucratic hurdles to leap” in the system, impeding communication. “In many places, the communication between G.P.’s and consultants in hospitals has become fragmented and distant,” he said.

The plan would also require all National Health Service hospitals to become “foundation trusts,” enterprises that are independent of health service control and accountable to an independent regulator (some hospitals currently operate in this fashion). This would result in a further loss of jobs, health care unions say, and also open the door to further privatization of the service.

It’s interesting how our government is trying to emulate Europe’s failed systems while the Europeans are backing away from them…